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Use of rapid diagnostic tests and choice of antibiotics in respiratory tract infections in primary healthcare: A 6-y follow-up study
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Clinical Physiology . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences.
2010 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 42, no 2, 90-96 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this retrospective study of electronic patient records in primary health care in Kalmar County, Sweden, was to describe consultations for respiratory tract infections (RTIs) in relation to age, choice of antibiotics and the use of rapid diagnostic tests. During the period 1999-2005, 240,445 visits for RTI were recorded. Children aged andlt;2 y and especially those aged 2-16 y with acute otitis media (AOM), showed decreasing consultations between 2000 and 2005. The consultations for sore throat declined during the study period in all age groups and in 65% of these, antibiotics were prescribed, primarily penicillin V (82%). In sore throat, a positive Strep-A test result was followed by antibiotic prescription in about 92% of cases, when negative, the antibiotic prescription rate was 40%. C-reactive protein (CRP) was analyzed in 36% of all consultations for RTI. In common cold and acute bronchitis, the prescription rates of antibiotics rose with rising CRP. The results show that near-patient tests were used extensively, but often not in accordance with the guidelines. Antibiotic use decreased mainly as a consequence of declined visiting frequencies. This indicates that the new guidelines for AOM and sore throat may have influenced patient consultation habits more than physician prescribing habits.

Place, publisher, year, edition, pages
2010. Vol. 42, no 2, 90-96 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-54388DOI: 10.3109/00365540903352932ISI: 000274849700002OAI: oai:DiVA.org:liu-54388DiVA: diva2:303551
Available from: 2010-03-12 Created: 2010-03-12 Last updated: 2017-12-12
In thesis
1. Treatment of Respiratory Tract Infections in Primary Care with special emphasis on Acute Otitis Media
Open this publication in new window or tab >>Treatment of Respiratory Tract Infections in Primary Care with special emphasis on Acute Otitis Media
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background and aims: Most respiratory tract infections (RTI) are self-limiting. Despite this, they are associated with high antibiotic prescription rates in general practice in Sweden. The aim of this thesis was to evaluate the management of respiratory tract infections (RTIs) with particular emphasis on acute otitis media (AOM).

Methods: Paper I: A prospective, open, randomized study of 179 children presenting with AOM and performed in primary care. Paper II & III: Study of 6 years data from primary care in Kalmar County on visits for RTI, retrieved from electronic patient records. Paper IV: Observational, clinical study of 71 children presenting with AOM complicated by perforation, without initial use of antibiotics.

Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Results: Children with AOM who received PcV had some less pain, used fewer analgesics and consulted less, but the PcV treatment did not affect the recovery time or complication rate (I). Between 1999 and 2005, 240 445 visits for RTI were analyzed (II & III). Antibiotics were prescribed in 45% of visits, mostly PcV (60%) and doxycycline (18%). Visiting rates for AOM and tonsillitis declined by >10%/year, but prescription rates of antibiotics remained unchanged. For sore throat, 65% received antibiotics. Patients tested but without presence of S.pyogenes received antibiotics in 40% of cases. CRP was analyzed in 36% of consultations for RTI. At CRP<50mg/l antibiotics, mostly doxycycline, were prescribed in 54% of visits for bronchitis. Roughly 50% of patients not tested received antibiotics over the years.Twelve of 71 children with AOM and spontaneous perforation completing the trial received antibiotics during the first nine days due to lack of improvement, one child after 16 days due to recurrent AOM and six had new incidents of AOM after 30 days (IV). Antibiotics were used more frequently when the eardrum appeared pulsating and secretion was purulent and abundant. All patients with presence of S.pyogenes received antibiotics.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2010. 85 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1166
Keyword
General practice, respiratory tract infections, acute otitis media, rapid diagnostic tests, CRP, Strep-A, electronic patient records, physician consultations, antibiotic prescription
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-54832 (URN)978-91-7393-446-6 (ISBN)
Public defence
2010-04-23, Aulan N2007, Linnéuniversitetet, Kalmar, 09:00 (English)
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Supervisors
Available from: 2010-04-15 Created: 2010-04-15 Last updated: 2010-04-15Bibliographically approved

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Neumark, ThomasBrudin, LarsMölstad, Sigvard

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